Intra -Post operative Nursing Management

1. Intra -Post operative Nursing Management Produced by Fatima Hirzallah

2. Intra operative phase • Is the time during the surgical experience that begins when the client is transferred to the operating room table and ends when the client is admitted to the post anesthesia care unit (PACU)

3. Principles of perioperative asepsis: • Preoperative • Preoperative sterilization of surgical materials • Placement of the operation room • Scrubbing of health team • Cleansing the patient’s skin with antiseptic agents • Covering the rest of pt’s body with sterile drapes

4. Intraoperative: Asepsis techniques in surgical practice • Post operative: • Protect the wound from contamination by sterile dressing • Heat compresses at site of surgery • Antimicrobial agents in infected wounds

5. Environmental control: • Sterilizing equipment • Laminar air flow system to filter out high percentage of dust and bacteria.

6. Principles regarding health and operating room attire • Clothing • Approved • Clean • Close-fitting cotton dressing • Mask : • No leak air • Shouldn’t interfere with breathing or hinder speech or vision • Compact and comfortable • Must be changed between operations

7. 2- Scrub activities • Scrubbing of the operation room • Setting up the sterile table, preparing sutures and special equipment • Assisting the surgeon and the surgical assistance • Keeping the time the patient is under anesthesia • Check all equipments used in operation are accounted • Send specimens to lab

8. Basic rules of surgical asepsis • General:Sterility of surface or articles • Personnel: Scrubbed personnel remain in the area of the operation . Only a small part of the scrubbed person’s body is considered sterile: from front waist to the shoulder area, forearm and gloves. • Drapping: • Delivery of sterile supplies • Fluids

9. Post operative phase • Is the time during the surgical experience that begins with the ends of the surgical procedure until the client transfer from operating room and goes to post anesthesia care unit (PACU)

10. Recovery Room: should have • Equipments: ( Breathing aids; oxygen, laryngoscope, tracheostomy set, bronchial instruments, catheters, mechanical ventilators, suction equipments, equipments for circulatory needs blood pressure, parental infusions. Surgical dressing materials, drugs especially emergency drugs.)

11. Immediate post operative nursing care: 1- Respiratory considerations The chief immediate post operative hazards are those of hypoxemia due to respiratory difficulties and shock Assessment Immediate post operative period : (ABC) Patency of air way Respiration Presence Oral air way-nasopharyngeal air way ,ETT SUCTIONING) O2 saturation Breath sound

13. level of consciousness Skin: A cold, pale, moist skin is a sign of vasoconstriction-hypovolmic shock Warm, red skin indicates septic or Neurogenic shock VITAL SIGNPulse and blood pressure: If each 5-15 minutes interval shows a fall in pulse and BP the indicate shock. Urinary output Shock can be prevented by administration of intravenous fluids and blood, appropriate drugs

14. Maintaining Cardiovascular Stability • To monitor cardiovascular stability, the nurse assesses the patient's mental status; vital signs; cardiac rhythm; skin temperature, color, and moisture; and urine output. Central venous pressure, pulmonary artery pressure, and arterial lines are monitored if the patient's condition requires such assessment. The nurse also assesses the patency of all IV lines..

15. The primary cardiovascular complications seen in the PACU include : hypotension and shock, hemorrhage, hypertension, and dysrhythmias

16. Hypotension and Shock • The classic signs of hypovolemic shock (the most common type of shock) are • Pallor • Cool, moist skin • Rapid breathing • Cyanosis of the lips, gums, and tongue • Rapid, weak, thready pulse • Narrowing pulse pressure • Low blood pressure • Concentrated urine

17. The pt remains in this room until he has full recovery from the anesthetic agents, stable blood pressure, adequate respiratory function, adequate oxygen saturation level compared with baseline, and spontaneous movement or movement on command.

18. the following measures are used to determine the patient's readiness for discharge from the PACU : • Stable vital signs • Orientation to person, place, events, and time • Uncompromised pulmonary function • Pulse oximetry readings indicating adequate blood oxygen saturation • Urine output at least 30 mL/hour • Nausea and vomiting absent or under control • Minimal pain

19. Post operative Nursing Management • goal is directed toward the reestablishment of the patient’s physiological equilibrium and the prevention of pain and complications. • Removing the patient from the operating table • The site of operation should be kept in mind every time. • Check positioning of the head ; extension, lying on unaffected site , • Check blood pressure; arterial hypotension • Remove the wet gown, keep the pt warm

20. Goals of post operative nursing care: • 1- To assist the pt in maintaining optimum respiratory function. Positioning Cleaning the airway (SUCTIONING Promoting lung expansion • 2-To assist the cardiovascular status of the pt and correct any deviation. • 3-To promote the comfort and safety of the pt Restlessness and discomfort Pain

21. 4- To promote hemostats through maintenance of fluid and electrolyte balance, proper nutrition and elimination. • 5- To enhance wound healing and avoid or control infection. Nosocomial infection • Invaded of skin and mucous membrane by tubes and catheters, by the disease process • Effect of surgery and anesthesia reduce resistance of the body .

22. Organisms in the hospitals • Poor hand washing practices • This can be reduced by: • Continuous health education about infection control policy • Deep breathing exercise to prevent accumulation of secretions • Sterilization of equipments • Antibiotics therapy

23. 6-To encourage activity through appropriate exercises, ambulation and Rehabilitation • Positioning • Ambulation • Ambulation increase respiratory exchange • Prevent stasis of bronchial secretions • Reduce distension • Prevent thrombophlebitis • Increase rate of wound healing • Ambulation done gradually

24. Bed exercises. • Deep- breathing exercises • Arm exercises • Hand and finger exercises • Foot exercises • Exercises to prepare pt for ambulatory activities

25. 7-Psychosocial well-being of the pt and his family. • Keep family in bed side for minutes • Expression of feelings • Participate in self care • Attractive grooming • 8-Document all phases of nursing process and report data • Any slight symptoms that can increase in severity • Any progressive and steady change for the worse in the general condition of the pt • The pt’s complaints

26. Post operative discomfort 1- Vomiting- Aspiration • Insert NGT during surgery • Drugs e.g. antiemetics may cause hypotension and respiratory depression • Prevent aspiration of vomitus -Turn the pt on his side lying position to provide effective drainage from the throat • Clean mouth frequently to facilitate breathing –SUCTIONING

27. 2-Abdominal distension . • 3-Thirst. (atropine). • 4-Constipation It can be treated by simple enema, ((Constipation has been described as a constant symptom of complete intestinal obstruction)) 5-Fecal Impaction • Remove the impaction • Enema of liquid petrolatum (oil enema) • Gloved finger